Individual
KENDRIX JERMAINE EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1811 EDWINA DR, VIDALIA, GA 30474-8963
(912) 538-9977
(912) 538-0770
Mailing address
919 HIDDEN RDG, IRVING, TX 75038-3813
(469) 282-2711
(469) 282-2609
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
21459
MS
208600000X
Surgery Physician
301950
LA
208600000X
Surgery Physician
Primary
83679
GA
208600000X
Surgery Physician
8406595-1205
UT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003221715A
—
GA
05
—
08771565
—
MS
05
—
2427458
—
LA
Enumeration date
06/10/2009
Last updated
10/17/2019
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